Pharmacology of Sedative-Analgesic Agents: Dexmedetomidine, Remifentanil, Ketamine, Volatile Anesthetics, and the Role of Peripheral Mu Antagonists

Panzer, Oliver; Moitra, Vivek K.; Sladen, Robert N.

doi:10.1016/j.ccc.2009.04.004

Cited by 165 publications

(124 citation statements)

References 153 publications

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“…5,6 The characteristics of the sedation produced by dexmedetomidine, lack of respiratory depression, and the 2013 Pain, Agitation, Delirium Guideline recommendation, has led to an increased use of dexmedetomidine in the ICU. 2,7,8 However, a wide variability in patient response to dexmedetomidine limits success in achieving sedation goals (treatment failures) in some patients. 8,9,10,11 It is therefore important to identify the patient factors that are associated with treatment response to best differentiate between patients that will achieve effective sedation and those that will not in order to optimize sedation care.…”

mentioning

confidence: 99%

Patient Predictors of Dexmedetomidine Effectiveness for Sedation in Intensive Care Units

Smithburger

Smith

Kane‐Gill

et al. 2014

American Journal of Critical Care

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Background Effective sedation is paramount in the care of critically ill patients. Dexmedetomidine, a selective α2- adrenergic receptor agonist, is an agent that is being increasingly used in the ICU despite its variability of patient response. Objective To report dexmedetomidine effectiveness and to identify specific patient characteristics that play a role in the achievement of adequate sedation with dexmedetomidine. Methods We conducted a 6 month, pilot, prospective observational study in a medical intensive care unit (MICU) at an academic medical center. Patients receiving dexmedetomidine were followed until drug discontinuation and were grouped into non-responders and responders. Effective sedation was defined as the achievement of a Sedation Agitation Scale (SAS) score of 3-4 after the addition of dexmedetomidine. Patient characteristics, laboratory values, home and inpatient medications, and dexmedetomidine dosing information were collected to identify predictors of clinical response. Results Thirty eight patients received dexmedetomidine in a 6 month time period, with dexmedetomidine being ineffective in 19/38 (50%) patients, effective in 11/38 (28.95%) patients, and effectiveness was unable to be assessed in 8 patients due to clinical confounders. Based upon the standard multiple logistic regression analysis, patients with a lower APACHE II (β coefficient −0.24; 95% CI, −0.39 to −0.03) and patients that received home antidepressants (β coefficient 2.33; 95% CI, 0.23 to 4.43) were more likely to achieve successful sedation with dexmedetomidine as compared to patients with a higher APACHE II score or no home antidepressant use. Conclusions Variability in effective sedation occurred with dexmedetomidine use. Future large scale investigations should be conducted to confirm the association of a lower APACHE II score and home antidepressant use and dexmedetomidine effectiveness.

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confidence: 99%

Patient Predictors of Dexmedetomidine Effectiveness for Sedation in Intensive Care Units

Smithburger

Smith

Kane‐Gill

et al. 2014

American Journal of Critical Care

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“…It is necessary to mention that the use of DEX beyond 24 hours may be associated with a dose-related increase in adverse events and for this reason, the Food and Drug Administration (FDA) has not recommended the use of DEX for more than 24 hours [27,28] . However, the safe use of this drug has been reported from 24 hours to more than a week [28,29] .…”

Section: Discussionmentioning

confidence: 99%

“…The common adverse events of DEX are hypotension at low blood concentrations, hypertension at high blood concentrations, bradycardia and nausea [29] . Most of these side effects occur at infusion of 0.2-0.7 mcg/kg/h without a bolus dose [28,31] .…”

Section: Discussionmentioning

confidence: 99%

“…DEX, a shorter-acting and highly selective presynaptic alpha-2-receptor agonist, also possesses pharmacologic sedative, hypnotic, anti-anxious, sympatholytic and analgesic properties [28] . Its analgesic and opioid-sparing effects are dose-dependent and trigger at spinal cord sites as well as through non-spinal mechanisms [29] . It has been suggested that alpha-2A receptors activation, inhibition of the C and A delta fibers signals conduction, and the local release of encephalin are the underlying non-spinal mechanisms of DEX to provide anti-nociception effects [34] .…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Dexmedetomidine on the Acute Pain After Cardiothoracic Surgeries: A Systematic Review

Hassani¹,

Kiabi²,

Sharifi³

2018

Braz J Cardiovasc Surg

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IntroductionAcute post-operative pain remains a troublesome complication of cardiothoracic surgeries. Several randomized controlled trials have examined the efficacy of dexmedetomidine as a single or as an adjuvant agent before, during and after surgery. However, no evidence-based conclusion has been reached regarding the advantages of dexmedetomidine over the other analgesics.ObjectiveTo review the effect of dexmedetomidine on acute post-thoracotomy/sternotomy pain.MethodsMedline, SCOPUS, Web of Science, and Cochrane databases were used to search for randomized controlled trials that investigated the analgesia effect of dexmedetomidine on post-thoracotomy/sternotomy pain in adults' patients. The outcomes were postoperative pain intensity or incidence, postoperative analgesia duration, and the number of postoperative analgesic requirements.ResultsFrom 1789 citations, 12 trials including 804 subjects met the inclusion criteria. Most studies showed that pain score was significantly lower in the dexmedetomidine group up to 24 hours after surgery. Two studies reported the significant lower postoperative analgesia requirements and one study reported the significant lower incidence of acute pain after surgery in dexmedetomidine group. Ten studies found that the total consumption of narcotics was significantly lower in the dexmedetomidine group. The most reported complications of dexmedetomidine were nausea/vomiting, bradycardia and hypotension.ConclusionDexmedetomidine can be used as a safe and efficient analgesic agent for reducing the postoperative pain and analgesic requirements up to 24 hours after cardiothoracic surgeries. However, further well-designed trials are needed to find the optimal dosage, route, time, and duration of dexmedetomidine administration.

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“…The preservation of hemodynamic stability with these drugs is an added advantage, especially in patients requiring long-term intensive care. [59]…”

Section: Sedation and Analgesiamentioning

confidence: 99%

Clinical and critical care concerns in severely ill obese patient

Bajwa

Sehgal

Bajwa

2012

Indian J Endocr Metab

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The incidence of obesity has acquired an epidemic proportion throughout the globe. As a result, increasing number of obese patients is being presented to critical care units for various indications. The attending intensivist has to face numerous challenges during management of such patients. Almost all the organ systems are affected by the impact of obesity either directly or indirectly. The degree of obesity and its prolong duration are the main factors which determine the harmful effect of obesity on human body. The present article reviews few of the important clinical and critical care concerns in critically ill obese patients.

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Pharmacology of Sedative-Analgesic Agents: Dexmedetomidine, Remifentanil, Ketamine, Volatile Anesthetics, and the Role of Peripheral Mu Antagonists

Cited by 165 publications

References 153 publications

Patient Predictors of Dexmedetomidine Effectiveness for Sedation in Intensive Care Units

Patient Predictors of Dexmedetomidine Effectiveness for Sedation in Intensive Care Units

The Effect of Dexmedetomidine on the Acute Pain After Cardiothoracic Surgeries: A Systematic Review

Clinical and critical care concerns in severely ill obese patient

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